Provider Demographics
NPI:1558661819
Name:CLAY WILSON & ASSOCIATES
Entity Type:Organization
Organization Name:CLAY WILSON & ASSOCIATES
Other - Org Name:THE COGNITIVE CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL RECORDS SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-327-6026
Mailing Address - Street 1:1109 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-2545
Mailing Address - Country:US
Mailing Address - Phone:828-327-6026
Mailing Address - Fax:828-327-8796
Practice Address - Street 1:1109 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-2545
Practice Address - Country:US
Practice Address - Phone:828-327-6026
Practice Address - Fax:828-327-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005415Medicaid